Greater Hospital Safety Encouraged

CMS is taking several actions to improve the quality of care in hospitals and reduce the number of “never events”—preventable medical errors resulting in serious consequences for the patient and “unnecessary costs to Medicare and Medicaid,” said CMS Acting Administrator Kerry Weems in a July 31 press release.

The inpatient prospective payment system (IPPS) rule displayed July 31 at the Office of the Federal Register adds three conditions, including one National Quality Forum (NQF) never event, to the Do Not Pay list.

The new conditions and events are:

  • Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity
  • Certain manifestations of poor control of blood sugar levels
  • Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

Beginning Oct. 1, Medicare will require hospitals to include a complication code in diagnostic related groups (DRGs) documenting whether a given complication was present on admission. Medicare will then determine whether the complication developed due to hospital mistakes—and if so, it won’t pay for care related to such mistakes.

CMS has posted three National Coverage Analysis (NCAs) addressing Medicare’s coverage of surgery on the wrong body part, surgery on the wrong patient, and wrong surgery on a patient. Additional details about open NCAs are available on the tracking sheets found on the coverage Web site.


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